CMS Memo Provides Agency Contact Information for Surprise Billing Disclosures

CMS has issued a memorandum to group health plans, insurers, and health care providers regarding agency contact information that must be included on certain notices and disclosures relating to the No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2021 (CAA). As background, the CAA and its interpreting regulations are intended to protect individuals from surprise bills for emergency services, air ambulance services furnished by out-of-network providers, and, under certain circumstances, non-emergency services furnished by out-of-network providers at in-network facilities. The CAA also includes a number of new transparency disclosures, including balance billing protection disclosures. For plan or policy years beginning on or after January 1, 2022, group health plans and insurers must post and include in all explanations of benefits to which the surprise billing rules apply a notice disclosing the prohibition on surprise billing and the entities to contact in the event of a violation. A model notice was provided in initial regulations (see our Checkpoint article), and use of the model will be considered good faith compliance (see our Checkpoint article).

The CMS memo explains that the model notice includes fields that must be completed by entering the URL for a government website describing the surprise billing protections as well as the contact information for applicable federal and state agencies. For this purpose, the memo identifies a CMS website that contains general information about the surprise billing rules. The memo indicates that the website is not yet fully functional, and consumer and provider functionality for complaints inquiry and triage will not be operational until January 2022. In addition, HHS will operate a telephone line beginning on January 1, 2022, for individuals to submit complaints regarding potential violations of the CAA; HHS will route complaints to the appropriate agency. The phone number (1-800-985-3059) should not be included in any plan documents for plan or policy years beginning before January 1, 2022.

EBIA Comment: The agencies have indicated that they may address the surprise billing disclosure requirements in more detail in future guidance or rulemaking. Until then, plans and insurers should make good faith efforts to comply for plan and policy years beginning in 2022 by using the model notice and the contact information provided in this memo. For more information, see EBIA’s Health Care Reform manual at Sections XII.B (“Patient Protections”) and XXXVII.E (“Surprise Medical Billing Transparency Disclosures”). See also EBIA’s ERISA Compliance manual at Section XXIV.P (“Transparency Disclosures for Group Health Plans”), EBIA’s Group Health Plan Mandates manual at Section XIII.B (“Patient Protections”), and EBIA’s Self-Insured Health Plans manual at Section XXVIII.I (“Surprise Medical Billing Transparency Disclosures”). You may also be interested in our upcoming webinar, “Required Notices for Group Health Plans: Is Your Inventory Up-to-Date?” (live on Nov. 10, 2021).

Contributing Editors: EBIA Staff.